Summary Objective To determine child mortality rates in a rural area of South Africa with high HIV prevalence. Methods A community-based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children
were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. Results Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant
and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person-years. HIV/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person-years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person-years
in children under 1 year of age. Conclusions In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.

Affiliations:1:
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK 2:
Department of Public Health Medicine, School of Family and Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 3:
Burden of Disease Research Unit, Medical Research Council, Cape Town, South Africa